The role of sustainability in the function of a company and more specifically a food company is pivotal for its financial performance. The environmental issues as well as the potential economic gains ...from the implementation of its principles ask for the use of multiple instruments that have been developed to green supply chains. Moreover, social issues also arise and involve the food companies social responsibility, as this can be realized through the supply of fresh products that meet consumption security standards. On this basis, the strategic design of these companies’ supply chains can assists them towards meeting their sustainability objectives as it may lead to the selection of transportation modes, location of entry points and distribution centers, and flows between the nodes of the networks under cost, environmental and social impact minimization criteria. Under this context the purpose of this manuscript is to develop and employ a multi-objective (namely cost, social-time and emission minimization) mixed integer linear programming decision-making model for the network design of sustainable supply chains of perishable food products. The specific model was implemented in the case of a fruits importer in the North-Eastern European region considering its geographical settings. To synopsize and according to our findings the suggested model is an easy to use decision-making tool that leads to a whole set of possible solutions incorporating trade-offs between three aspects of sustainability.
Freshwater overexploitation and scarcity have led to extensive shifts in demand patterns for water-friendly products. As several agricultural and industrial activities are closely intertwined with ...water consumption, the availability of sufficient freshwater resources constitutes a significant precondition for covering global consumer needs. In this context, the design and management of sustainable supply chains in terms of freshwater resources' preservation have emerged as major challenges in the corporate agenda. As such, the concept of water footprint as a key performance indicator of freshwater utilization has been introduced at national, corporate and product levels. In this manuscript, we first provide a critical literature synthesis concerning product water footprint assessment in order to map the state-of-the-art research related to freshwater consumption and pollution in the agricultural and industrial sectors. Our analysis demonstrates that although water footprint assessment is a rapidly evolving research field, scientific publications focusing on a holistic approach concerning freshwater exploitation at a supply chain extent are rather limited. The findings further verify that the agrifood sector dominates global water use. In this respect, we analyse both corporate and academic literature in order to identify emerging issues on freshwater resources' management for agrifood products. Finally, we propose a first-effort hierarchical decision-making framework that includes water footprint mitigation policies for agrifood supply chains in order to support all stakeholders in developing a comprehensive water stewardship strategy.
•We provide a literature synthesis on product water footprint (WF) assessment.•Research on holistic WF accounting at a supply chain level is rather limited.•The agrifood sector dominates global freshwater utilization.•WF mitigation practices are identified in the academic and corporate literature.•We propose a decision-making framework for WF management in agrifood supply chains.
Abstract Background Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life. Objectives To identify factors that lead to the ...occurrence of severe perineal lacerations. Search strategy We searched MEDLINE, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies. Selection criteria We included prospective and retrospective observational studies. Data collection and analysis Predetermined data were collected and analyzed with the Mantel–Haenszel fixed-effects model or the DerSimonian–Laird random-effects model. Main results The meta-analysis included 22 studies (n = 651 934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g 95% CI, 139.80–245.96 g), an episiotomy (OR 3.82 95% CI, 1.96–7.42), or an operative vaginal delivery (OR 5.10 95% CI, 3.33–7.83). Epidural anesthesia (OR 1.95 95% CI, 1.63–2.32), labor induction (OR 1.08 95% CI, 1.02–1.14), and labor augmentation (OR 1.95 95% CI, 1.56–2.44) were also more common among women with perineal lacerations. Conclusions Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation.
To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device.
Stepwise ...demonstration of the technique with narrated video footage.
Bowel endometriosis is a common pattern of deep endometriosis 1. Discoid excision is 1 of the 3 surgical interventions applied to manage this pathologic entity, with shaving and segmental resection being the other 2 2. When discoid excision is performed, a transanal stapler device is used for bowel closure in most cases 3,4. Only a few studies so far have reported the application of sutures for this purpose 5. This video highlights the technique of bowel suturing after discoid excision.
This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect (Supplemental Video 1). The key surgical steps are as follows: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve. 3. Detachment of the nodule from the cervix. 4. Detachment of the nodule from the bowel, beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using 2 layers of Vicryl 3-0 sutures, the first being interrupted and the second continuous.
The described technique of bowel closure using sutures may be a safe and effective alternative to the transanal stapler. Its advantage is that it can be performed when the pathology is located higher than 15 cm from the anal verge or the diameter of the nodule is more than 30 mm.
•Chemotherapy response score is a valuable tool that helps determine patients at risk of earlier relapse and death.•The importance of debulking surgery remains significant even in those with minimal ...response to chemotherapy.•Survival differences of CRS 1-2 vs CRS 3 patients were similar to those of patients with platinum resistant vs sensitive disease.
The chemotherapy response score (CRS) has been widely adopted as a predictive tool for ovarian cancer survival. In the present study, we seek to define differences in survival rates among patients grouped in the traditionally established three-tiered system and those who have not been offered debulking surgery.
We designed a retrospective cohort study involving women treated with chemotherapy and offered interval or late debulking surgery for ovarian cancer. Twenty-eight women were not considered for a debulking procedure for various reasons. Of the 89 women who were finally offered interval debulking or late debulking surgery, 28 had a CRS 1 score, 34 had a CRS 2 score and 27 had a CRS 3 score.
Significant differences were noted in the progression-free survival (PFS) and overall survival (OS) of patients based on the CRS stratification, although survival rates were considerably longer for all three groups compared to those of patients who were not offered surgery. Cox regression univariate analysis revealed that suboptimal debulking and CRS 1 or no surgery had a significant negative impact on PFS and OS rates. The binary stratification of CRS (CRS 1–2 vs CRS 3) revealed comparable differences in the PFS and OS to those in the groups that were stratified as platinum resistant and platinum sensitive.
The chemotherapy response score is a significant determinant of ovarian cancer survival that helps evaluate the risk of early disease relapse and death and may soon be useful in guiding patient-tailored treatment.
Considering that more than 100 million EU citizens face the risk of poverty or social exclusion, while at the same time 35% of perishable food in the EU is unnecessarily discarded at supermarkets, ...the redistribution of the perishable food surpluses could provide an economically feasible solution towards the confrontation of poverty and the minimization of food waste. Under this context, the purpose of this paper is to propose a novel quantitative decision-making tool that optimizes a retailer’s replenishment policy for perishable products while minimizing the amount of perishable items discarded after they approach their expiration dates, through the timely donation of a part of their net stocks.
Background
We investigated the impact of pulmonary recruitment maneuver in reducing shoulder pain after laparoscopic procedure.
Methods
We conducted a systematic review of the literature using ...Medline (1966–2014), Scopus (2004–2014), Popline (1974–2014),
www.ClinicalTrials.gov
(2008–2014), and Google Scholar (2004–2014) along with reference lists of electronically retrieved studies. Statistical meta-analysis was performed using the RevMan 5.1 software.
Results
Six studies were included in the present systematic review, involving 571 patients. Among them, 291 (51 %) were offered a pulmonary recruitment maneuver, and 280 patients (49 %) were treated with conventional evacuation of pneumoperitoneum that included either passive evacuation or gentle pressing of the abdominal walls with the trocar ports open. The introduction of a pulmonary recruitment maneuver significantly decreased postoperative shoulder pain 12 h (435 patients, REM, MD −1.55, 95 % CI −2.01, −1.10), 24 h (435 patients, REM, MD −1.59, 95 % CI −2.00, −1.18), and 48 h post-operatively (335 patients, REM, MD −0.93, 95 % CI −1.37, −0.50). We also identified evidence of a potential beneficial effect in the reduction of postoperative upper abdominal pain. However, discrepancies in the interpretation of abdominal pain among the included studies precluded meta-analysis of this index.
Conclusions
According to the results of our meta-analysis, pulmonary recruitment maneuver seems to be an easily performed, potentially preventive measure of post-laparoscopic shoulder pain. Further research is mandated, however, in the field, because firm results are precluded by the small number of included studies.
The Mediterranean diet (MedDiet) has been linked with physical and mental health benefits. Previous research, however, suggests that adoption and adherence to a Mediterranean diet might be difficult ...for people who live outside of the Mediterranean region. The aim of this systematic review was to investigate the factors that influence adoption and adherence to a Mediterranean style diet in adults aged 18 years old and over, as identified in published observational and qualitative studies. Following registration of our protocol on PROSPERO (ID: CRD42018116515), observational and qualitative studies of adults’ perceptions and experiences relevant to following a Mediterranean style diet were identified using systematic searches of databases: MEDLINE, the Cochane Library, CINAHL, Web of Science and Scopus, over all years of records until February 2022. A narrative synthesis was then undertaken. Of 4559 retrieved articles, 18 studies fulfilled our inclusion criteria and were included. Factors influencing adoption and adherence to a MedDiet were identified and categorized as: financial, cognitive, socio-cultural, motivational, lifestyle, accessibility & availability, sensory & hedonic and demographic. Similar barriers and facilitators are often reported in relation to healthy eating or the consumption of specific healthy foods, with a few exceptions. These exceptions detailed concerns with specific components of the MedDiet; considerations due to culture and traditions, and concerns over a cooler climate. Suggestions for overcoming these barriers and facilitators specific to adoption and adherence to the Mediterranean diet are offered. These data will inform the development of future studies of robust methodology in eating behaviour change which offer pragmatic approaches for people to consume and maintain healthy diets.
To present the case of a young patient with an Altman type IV sacrococcygeal teratoma (Fig 1) managed exclusively with laparoscopy.
A step-by-step demonstration of the technique.
A 24-year-old ...patient complaining of dysmenorrhea, deep dyspareunia, chronic constipation, dyschezia, and bladder atony was diagnosed with a 5-cm cystic tumor compressing the low rectum and overlying the left levator ani muscle.
Laparoscopic excision of the tumor. At laparoscopy, significant bilateral pelvic venous congestion was found. The left medial and lateral pararectal fossa and the rectovaginal space were developed to the level of the pelvic floor. Several branches of the left internal artery and vein were dissected. The left hypogastric nerve and deep hypogastric plexus were dissected in an effort to preserve ipsilateral autonomic nerve supply to the rectum. Owing to the tumor's soft consistency and dense adherence to the surrounding structures, transrectal sonography facilitated dissection, which was performed medially to the mesorectal fascia and anteriorly to the presacral fascia. The middle sacral artery and peripheral branches of the internal iliac vasculature supplying the tumor were ligated. Part of the left levator ani had to be excised. The rectum was injured during the effort to detach the tumor from its lateral wall. The injury was repaired laparoscopically. The cut edge of the levator ani was used as a flap to reinforce the repair.
Sacrococcygeal teratomas lying entirely in the pelvis (Altman type IV) are extremely rare 1,2. Complete laparoscopic excision is challenging and potentially dangerous 3-5, but it is feasible with careful dissection.
Total laparoscopic hysterectomy (TLH) may be indicated in patients with deep infiltrative endometriosis (DIE) to treat severe chronic pelvic pain symptoms, recurrences, or co-existing uterine ...disease. This study discusses the challenges and specific operative and postoperative considerations in patients submitted to TLH and excision of DIE, in comparison with those undergoing a procedure for other benign indications.
Patients undergoing TLH and excision of DIE were included (N = 18, group 1). These were matched with cases, treated with TLH for other benign indications during the same period (2010–2019), at a 2:1 ratio (N = 36, group 2). The two groups were compared with regards to their characteristics, and intraoperative and postoperative data, including operative time, estimated blood loss (EBL), hospital stays, and rates of complications.
In group 1, median DIE nodule size was 2.5 cm (range: 1.3–4.2). Simple hysterectomy was performed in 10, and a more extended procedure in 8 cases. All nodules were removed from the bowel wall using the shaving technique. Average EBL was significantly higher (p = .027), and duration of surgery and hospital stays longer (p = .003, and p = .0001, respectively), in group 1 vs. group 2. The rates of long-term (L-T) complications were higher in group 1 but not to a significant level (p = .087). Analysis within the DIE group showed that operative time was significantly related to nodule size, type of hysterectomy (p = .021), presence of adenomyosis (p = .041), uterine size ≥12weeks (p = .039), and the occurrence of L-T complications (p = .016). Increasing nodule size and an extended procedure (p = .005) increased significantly the EBL, which had also a significant effect on the risk of L-T complications (p = .006).
TLH in DIE patients is a different, complex and potentially more dangerous procedure compared with TLH for other benign indications. Thorough knowledge of retroperitoneal anatomy, a clear operative plan, and excellent laparoscopic skills are necessary for concomitant radical excision of lesions, with low rates of adverse events.
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